Permit CITY TIGARD. MECHANICAL PERMIT
PERMIT #: MEC2001 -00390
DEVELOPMENT SERVICES DATE ISSUED: 11/5/01
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110DC -02200
SITE ADDRESS: 15660 SW PACIFIC HWY /I
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN: •
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
GAS OUTLETS
> 10000 cfm: OUTLETS: 1
Remarks: Relocate gas line and outlet.
Owner: FEES
TIGARD CENTER Type By Date Amount Receipt
9777 WILSHIRE BLVD. PRMT CTR 11/5/01 $72.50 2720010000
#609 5PCT CTR 11/5/01 $5.80 2720010000
BEVERLY HILLS, CA 90212
Total $78.30
Phone:
Contractor:
DAVID SMITH PLUMBING
9545 SW KILLARNEY LN.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Gas Line lnsp
Phone: 503 - 691 -2930 Final Inspection
Reg #: LIC 100030
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by call�g
mnwaR_a1 R;
Issue By: AP Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for inspections neeed the next business day
Mechanical Application
Date received: t i fj' o) Permit no.10 / DU 3
A I! City of Tigard Project/appl. no.: Expire date:
of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
City f 8 Phone: (503) 639-4171 Date issued: By9p Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
0 I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCIIEDULE
Job address: T • (p D S_ h/ . r Q t t G 14- (W/Ji 4- Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: (Block: Subdivision: *See checklist for important application information and
Project name: ID 7 a u, s VI jurisdiction's fee schedule for residential permit fee.
City /county: ¶ 1 ,,,,, I ZIP: 9 7Z7-€4- 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
7 e Ve. G x.S fo s"t"ove, Fee(ea) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
space insulated? 0 Yes 0 No Air conditioning rati of xi ta plan HVAC Is existing system
g P Alteration of existing HVAC system
MECIIANICAL CONTRACTOR Boiler /compressors
Business name: D 4 / . ((,vyyi b,, �ivG State boiler permit no.:
HP Tons BTU /H
Address: 1 r� .,GU, k; /l4 rin e,. Fire /smoke dampers/duct smoke detectors
City: i (A. I State' P 'L Heat pump (site plan required)
Phone: 6,11-21 30 I Fax: I E -mail: Install/replacefurnace/burner BTU /H
Including ductwork/vent liner U Yes 0 No
CCB no.: f 600 3 Install/replace/relocate heaters— suspended,
City /metro lic. no.: 3g• 30 wall, or floor mounted
Name (please print): Da V id N. S 171 / W, Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: I State: I ZIP: Type: LPG x NG Oil
Phone: Fax: E -mail: Fuel pi ing each additional over 4 outlets
rocess pip g (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type
Phone: Fax: . I E -mail: Woodstove/pellet stove
Other:
` I Applicant's signature: p • �) l ie: ((_ O Other. -
r Name (print): /�/� �
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ /d •�
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan review
Credit card number: Expires / wit hin 180 days after it has been ( at % ) $
State surcharge (8 %) .... $ �
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $ 7 D 3d
Cardholder signature Amount 440-4617 (6/00/COM)
'p.
MECHANICAL PERMIT FEES ,
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp ••
Minimum Permit Fee $72.50 SUBTOTAL: 7) <3HP; absorb unit
$ to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM
1 0.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in applicance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101 k to 500k BTU 10.00
15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU / 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 $
>1.75 mil. BTU
Minimum Permit Fee $72.50 SUBTOTAL:
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
appliance permit
• Hood served by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator 1 170 1 Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
Other unit, including wood stoves, 656 $72.50 per hour
inserts, etc. 3. Additional plan rev req'uved by charges, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -ha our) $72.50 per hour
Each additional outlet 63
State Contractor Boller eon required for units >200k BTU.
TOTAL COMMERCIAL $ "Residential A/C requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
i:\dsts\forms\mech- fees.doc 08/29/01
`CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Maur Inspection Line: 639 -4175 Business Line: 639 -4171
Date Requested 5 PM BL
Location /5 660 S �4 / C �7 - -' Y Suite ME 0 403%
Contact Person 5 r / /a,,1 €/,-/ 9 Ph (9 q f 6 ,'30
Contractor / Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PAS FAIL
CHANICA
am
Smmpers
PART FAIL
� RICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk (—
Other Date U I Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MSS
BUP 2Z0( oo 4J
Received Date Requested 3 � _ AM PM BUPA
Location / -5 Suite i /- cc-?6
Contact Person (��`�!� Ph ( ) 6 : PLM
Contractor Ph ( ) SWR
•
ILDING Tenant/Owner i /�.� l ,Q 0t ELC
in Uo
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 9 441 l SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
�)�• FAIL FCC
e I : ING ' 6 .
Post & Beam ( X
Under Slab
Water he
Water Service
Sanitary Sewer /l J
Rain Drains ! v
Catch Basin / Manhole
Storm Drain
Shower Pan -
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ri Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3/c/ b Z Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL